Clinical Audit Tool - Medtech Global · not have CVDR recorded HN (M/P/I) F 45-74 no CVDRA Rec All...

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Release Notes

Clinical Audit Tool

Version 1.0.45 Update

(June 2012)

These Release Notes contain important information for all Medtech Users. Please ensure that

they are circulated amongst all your staff. We suggest that these notes are filed safely for future reference.

Clinical Audit Tool Release Notes


Table of Contents

Issues Resolved in this Update ................................................................................................................... 3

High Need (HN) Patient Definition Change ........................................................................................ 3

HealthStat Query Related Issues: ...................................................................................................... 4

Screening – HbA1c % Values Converted to mmol/mol Values ........................................................ 10

Removed Save Query Icon .............................................................................................................. 11

Reports > Pre Deined Queries > Screening Management ............................................................... 11

Same Vaccination being Shown Multiple Times .............................................................................. 12

Resolved Issue when Mapping Multiple Screening Terms .............................................................. 13

Enhancements in this Update .................................................................................................................... 14

New Filter to Display High Needs Patients ...................................................................................... 14

Displaying Patient’s Telephone Number .......................................................................................... 14

Reports Section: Graph Labels ........................................................................................................ 15

Usage Notes .............................................................................................................................................. 18

To proceed further if “Zero Records” found scenario encountered. ................................................. 18

Exporting to Excel Sheet – Out of Memory Exception ..................................................................... 18



Issues Resolved in this Update

High Need (HN) Patient Definition Change The High Need (HN) Patient definition that was used to retrieve HN Patients in CAT > Reports > PPP Queries and HealthStat > PPP queries is not correct and all HN related queries have been changed to the correct definition. Below is the previous definition of HN and the new definition of HN for comparison:

Previous Generic HN Definition (Incorrect):

• 21 - NZ Maori • 30 - Pacific Island (Not Further Defined) • 37 - Other Pacific Island • Quintile 5 (NZDep decile 9 or 10)

New/Revised Generic HN Definition (Correct):

• 21 - NZ Maori • 30 - Pacific Island (Not Further Defined) • 31 – Samoan • 32 - Cook Island Maori • 33 – Tongan • 34 – Nuiean • 35 – Tokelauan • 36 – Fijian • 37 - Other Pacific Island and • Quintile 5 (NZDep decile 9 or 10) (ANY ethnicity)

Below is the list of generic High Need queries that have been updated to reflect the new definition for High Need Patient:

Query Short Form

All high need patients with diagnosis of DM that have not had a review in the last 12 months

HN with Dx of DM no review last 1 Yr

Funded high need women patients aged 20 - 69 without cervical smear recorded in the last 3 yrs

Fund HN F 20-69 no Cx last 3 Yr

Funded high need women patients aged 50-64 without mammogram done in the last 2 years

Fund HN F 50-64 no MAM last 2 Yr



All high need patients 65+ and with known diagnosis of asthma/diabetes/IHD that have not had a flu immunisation since the beginning of the year, based on the flu immunisation code in PMS

HN 65+ Dx Asthma/DM/IHD, no flu Imms

All high need patients with prescription for hypoglycaemic not recorded as having DM

HN 15-79 Rx Hypoglycaemic, no DM Rec

HealthStat Query Related Issues: 1) PPP CVD Risk Assessment Query Update

The existing HealthStat PPP CVD Risk Assessment queries have been updated to reflect the changes made to the High Need (HN) Patient definition to retrieve correct and accurate data.

The following queries have been changed under the PPP Queries:

PPP > CVD Risk Assessment All



Populations included in CVD Risk Assessment All indicator

Maori, Pacific and Indian subcontinent WOMEN aged 45-74

Maori, Pacific and Indian subcontinent MEN aged 35-74

All other ethnicities MEN aged 45-74

All other ethnicities WOMEN aged 55-74

Below is the list of generic CVDR All queries that have been updated in CAT according to the revised HN definition:

Query Short Form

All high need (Maori/Polynesian/Indian sub continent) female patients aged 45-74 that do not have CVDR recorded

HN (M/P/I) F 45-74 no CVDRA Rec

All high need (Maori/Polynesian/Indian sub continent) male patients aged 35-74 that do not have CVDR recorded

HN (M/P/I) M 35-74 no CVDRA Rec

All other ethnicities - female patients aged 55-74 that do not have CVDR recorded

Other Ethnicity F 55-74 no CVDRA Rec

All other ethnicities - male patients aged 45-74 that do not have CVDR recorded

Other Ethnicity M 45-74 no CVDRA Rec

For All other ethnicities queries – it will exclude ethnic codes related to Maori (21), Pacific Island Group (30 – 37) and Indian (43).

Revised Other Ethnicity Definition:

• Not 21 - NZ Maori • Not 30 - Pacific Island (Not Further Defined) • Not 31 – Samoan • Not 32 - Cook Island Maori • Not 33 – Tongan • Not 34 – Nuiean • Not 35 – Tokelauan • Not 36 – Fijian • Not 37 - Other Pacific Island • Not 43 – Indian



PPP > CVD Risk Assessment High Need (HN)

Populations included in CVD Risk Assessment HN indicator

Maori, Pacific and Indian subcontinent WOMEN aged 45-74

Maori, Pacific and Indian subcontinent MEN aged 35-74

All other ethnicities under Quintile Q5- MEN aged 45-74

All other ethnicities under Quintile Q5 - WOMEN aged 55-74

Below is the list of generic CVDR HN queries that have been updated in CAT according to the revised HN definition:

Query Short Form

All high need (Maori/Polynesian/Indian sub continent) female patients aged 45-74 that do not have CVDR recorded


All high need (Maori/Polynesian/Indian sub continent) male patients aged 35-74 that do not have CVDR recorded


All other ethnicities (Quintile 5) - female patients aged 55-74 that do not have CVDR

Other Ethnicity (Quintile 5) F 55-74



recorded

(Excluding 21, 30, 31, 32, 33, 34, 35, 36, 37, 43 Ethnicity)

no CVDRA Rec

All other ethnicities (Quintile 5) - male patients aged 45-74 that do not have CVDR recorded

(Excluding 21, 30, 31, 32, 33, 34, 35, 36, 37, 43 Ethnicity)

Other Ethnicity (Quintile 5) M 45-74 no CVDRA Rec

For other ethnicities Q5 queries – it will exclude ethnic codes related to Maori (21), Pacific Island Group (30 – 37) and Indian (43); and consider all other remaining ethnicities that come under Q5 population.

Revised Other Ethnicity Q5 Definition (Correct):

• Quintile 5 (NZDep decile 9 or 10) (ANY ethnicity) • Not 21 - NZ Maori • Not 30 - Pacific Island (Not Further Defined) • Not 31 – Samoan • Not 32 - Cook Island Maori • Not 33 – Tongan • Not 34 – Nuiean • Not 35 – Tokelauan • Not 36 – Fijian • Not 37 - Other Pacific Island • Not 43 – Indian

2) PPP Flu 65+ Query Change

The PPP Flu 65+ queries have been modified in CAT to reflect changes made to the criteria used in the relevant HealthStat queries.

Old Query - All Registered patients 65+ with diagnosis of asthma/diabetes/IHD that haven't had Flu 65+ immunisation since beginning of year. New Query - Registered patients 65+ and Registered patients who have diagnosis of asthma/diabetes/IHD that haven't had Flu 65+ immunisation since beginning of year. Old Query - High Needs patients 65+ with diagnosis of asthma/diabetes/IHD that haven't had flu immunisation since beginning of year.



New Query - High Needs patients 65+ and High Needs patients who have diagnosis of asthma/diabetes/IHD that haven't had flu immunisation since beginning of year.

The new queries will find registered patients who are above 65+ and patients who have either a diagnosis of asthma, IHD or Diabetes (age is irrelevant for patients identified with asthma, IHD or Diabetes for receiving the Flu 65+ vaccination).

3) Addition of Brand Names under Inhaled Steroids for the Asthma Coding Completeness Query

The existing Coding Completeness query is as follows:

"All pats under 45 on inhaled steroid not recorded as having asthma"

The current CAT query only uses ”11.D” MIMS Subsection code.

The same HealthStat query checks for certain Inhaled Steroid brand names as part of its search. In order to maintain consistency between CAT and HealthStat; the CAT query has been updated to reflect this.

Below is a list of Brand Names included in the query: BECLAZONE BUDENOCORT FLIXOTIDE PULMICORT QVAR SERETIDE SYMBICORT VANNAIR

4) HealthStat Queries – All Patients queries showing Casual & Deceased Patients

Many queries coming from HealthStat into CAT have been showing Casual and Deceased patients instead of displaying only Registered patients. This was due to the query looking for “All” patients without applying filtering based on the Registration status of the patient.

The below queries have been altered to search for Registered patients rather than “All” patients:

Patients with read code for breast cancer Patients with read code for breast cancer Patients with read code for Cervical cancer Patients with read code for Colon cancer Patients with read code for Lung cancer



Patients with read code for Prostrate cancer Patients with read code for Diabetes Patients with read code for High Blood Pressure Patients with read code for Heart failure Patients with read code for IHD Patients with read code for Acute Rheumatic Fever All pats under 45 on inhaled steroid not recorded All pats with prescription for hypoglycemic, no DM rec All pats with hdl < 1 mmol/l All pats with tg > ?1.5mmol/l All pats with cholesterol > 6.0 All pats with sys BP > 160 or dia BP > 100 All pats with 5 yr CVD risk > 15 All Asian with 5 yr CVD risk > 15 All Maori with 5 yr CVD risk > 15 All Other with 5 yr CVD risk > 15 All Pacific with 5 yr CVD risk >15 All pats with 5yr CVD risk > 15 not on aspirin All pats with 5yr CVD risk > 15 not on statin All F 45-74 high need (M/P/Indian sub continent) pats that don't have CVDR recor All F 55-74 non high need pats that don't have CVDR recorded All M 35-74 high need (M/P/Indian sub continent) pats that don't have CVDR recor All M 45-74 non high need pats that don't have CVDR recorded All patients with diagnosis of DM that haven't had review in last 12 months Pats with Rx for depression but not Dx All pats 65+ and with known diag asthma / dm / ihd that have not had flu imm sin All pats with prescription for nitrate not recorded All patients with diagnosis of DM that haven't had review in last 12 months, High Needs All pats with prescription for hypoglycemic, no DM rec , aged 15-79 All pats with prescription for hypoglycemic, no DM rec , aged 15-79 high needs All pats 65+ and with known diag asthma / dm / ihd that have not had flu imm HN

5) HealthStat > PPP > Smoking Recorded Query Correction

The PPP > Smoking Recording was previously returning inaccurate results - patients aged 15 to 75. The query has been updated and now returns patients aged 15 to 74.



Screening – HbA1c % Values Converted to mmol/mol Values Since 3rd October 2011 Medtech32 has been receiving HBA1c results from labs in mmol/mol units rather than %. This change is a result of an international standard that was introduced in early 2009, which gave laboratories a 2-year period to implement (2011).

Menu Navigation: Screening > HbA1c

This update will display HbA1c values (“HbA1c” and “HbA1c Range” columns) in mmol/mol format instead of % format. It will automatically convert all existing % values to mmol/mol format.

Below is the new HbA1c range that will be displayed:

Previous HbA1c Range New HbA1c Range

Less than 7% Less than 53 mmol

Between 7% to 8% Between 53 mmol to 64 mmol

Between 8% to 10% Between 64 mmol to 86 mmol

Greater than 10% Greater than 86 mmol

The below equation is used to convert existing HbA1c % values to mmol/mol values:

IFCC-HbA1c (mmol/mol) = [DCCT-HbA1c (%) - 2.15] x 10.929

The old, percentage way of reporting HbA1c values is known as the DCCT (Diabetes Control and Complications Trial) units.

The new mmols/mol values are known as the IFCC (International Federation of Clinical Chemistry) units.

The equation can be simplified to:

[Hba1c % value - 2.15] x 10.929 = Hba1c mmol value

For example - Converting HbA1c 5 % to mmol value:

[5 - 2.15] x 10.929 = 31.14765

Rounding mmol/mol values:

The mmol/mol value will be rounded off using the Common Rounding Algorithm. Values less than .5 is 0 (rounded down) and equal or more is 1 (rounded up).



Screenshot of the HbA1c Range and HbA1c Data Grid with MMOL Values under the HbA1c Column

Removed Save Query Icon The Save Query Icon has been removed from main navigation menu.

Reports > Pre Deined Queries > Screening Management The incorrect label for “Reg >= 16 no SM Rec” has been corrected to “Reg >= 15 no SM Rec”

Displays patients that are 15 to 74 years old with no smoking status recoded.



Same Vaccination being Shown Multiple Times Previously there were instances in the “Immunisation” screen where the same vaccine that had been given to a patient multiple times was being shown as multiple records rather than showing only the latest entry.

Only the latest entry of the same type of vaccination is being shown in CAT after applying this update

Screenshot showing same vaccine (Flu 65+) entered multiple times in MT32 and displaying only the latest entry in CAT



Resolved Issue when Mapping Multiple Screening Terms

If multiple screening terms are mapped in Screening Mapper for negation condition, only the first mapped screening term was being considered. Hence returning incorrect values when viewing reports. E.g. 'Funded >=35 no CVDR Rec'

This Issue has been resolved and now it considers all of the Screening Terms mapped to a particular measurement. E.g. CVD.



Enhancements in this Update

New Filter to Display High Needs Patients A new High Needs Filter called “Only High Needs Patients” has been added under the Preliminary Filter. This allows the user to filter and display only High Needs Patients.

Note: High Need patients are those who have ethnicity of Maori (ethnic code 21), Pacific Island People (ethnic code 30–37) and those who fall under NZ Deprivation code of Quintile 5 (Decile 9 or 10).

• 21 - NZ Maori • 30 - Pacific Island (Not Further Defined) • 31 – Samoan • 32 - Cook Island Maori • 33 – Tongan • 34 – Nuiean • 35 – Tokelauan • 36 – Fijian • 37 - Other Pacific Island

and • Quintile 5 (NZDep decile 9 or 10) (they can come from any ethnicity)

Displaying Patient’s Telephone Number A new column has been included in the “Demographics” screen data grid to display a patient’s Work Phone number (Day Phone)



Screenshot of new Day Phone Number

Reports Section: Graph Labels The graph labels and tool tips that were being displayed under Reports section have been altered. This has been done to make graph labels consistent and shorter as some of the labels were getting cut off.

Below is a table displaying Report Type, Full Description and New Short Form for the graph labels:

Report Full Description New Short Form

PPP Queries All funded patients aged >= 35 that have never had a CVD risk recorded

Fund >=35 no CVDR Rec

PPP Queries All high need (Maori/Polynesian/Indian sub continent) female patients aged 45-74 that do not have CVDR recorded


PPP Queries All other ethnicities- female patients aged 45-74 that do not have CVDR recorded

Other Ethnicity F 55-74 no CVDRA Rec

PPP Queries All high need (Maori/Polynesian/Indian sub continent) male patients aged 35-74 that do not have CVDR recorded


PPP Queries All other ethnicities- male patients aged 35-74 that do not have CVDR recorded

Other Ethnicity M 45-74 no CVDRA Rec

PPP Queries All patients with diagnosis of DM not reviewed in the last 12 mths

Reg with Dx of DM no review last 1 Yr

PPP Queries All high need patients with diagnosis of DM that have not had a review in the last 12 months

HN with Dx of DM no review last 1 Yr

PPP Queries Funded women patients aged 20 - 69 without cervical smear recorded in the last 3 yrs

Fund F 20-69 no Cx last 3 Yr




PPP Queries Funded high need women patients aged 20 - 69 without cervical smear recorded in the last 3 yrs

Fund HN F 20-69 no Cx last 3 Yr

PPP Queries Funded high need women patients aged 50-64 without mammogram done in the last 2 years

Fund HN F 50-64 no MAM last 2 Yr

PPP Queries All patients 65+ and with known diagnosis of asthma/diabetes/IHD that have not had a flu immunisation since the beginning of the year, based on the flu immunisation code in PMS

Reg 65+ Dx Asthma/DM/IHD, no flu Imms

PPP Queries All high need patients 65+ and with known diagnosis of asthma/diabetes/IHD that have not had a flu immunisation since the beginning of the year, based on the flu immunisation code in PMS

HN 65+ Dx Asthma/DM/IHD, no flu Imms

PPP Queries All patients with prescription for hypoglycemic not recorded as having DM

Reg 15-79 Rx Hypoglycemic, no DM Rec

PPP Queries All high need patients with prescription for hypoglycemic not recorded as having DM

HN 15-79 Rx Hypoglycemic, no DM Rec

Screening Management

Registered patients >= 35 with no BP recorded in the last 5 years

Reg >=35 no BP Rec last 5 Yr


Registered patients >= 35 whose smoking has not been recorded

Reg >=35 no SM Rec


Registered patients >= 16 whose smoking has not been recorded

Reg >=16 no SM Rec


Registered patients >= 35 with no LDL recorded

Reg >=35 no LDL Rec


Registered patients >= 35 with no HDL recorded

Reg >=35 no HDL Rec


Registered patients >= 35 with no total cholesterol recorded

Reg >=35 no TOC Rec


Registered patients >= 10 with no height recorded

Reg >=10 no HT Rec


Registered patients >= 10 with no weight recorded

Reg >=10 no WT Rec

Register Management

Registered patients with no age recorded Reg no Age Rec

Register Registered patients with no ethnicity Reg no Ethnicity Rec



Report Full Description New Short Form Management recorded

Register Management

Registered patients with no gender recorded Reg no Gender Rec

Register Management

Registered patients with no NHI no. recorded Reg no NHI Rec

Chronic Disease Management

All patients with 5 yr CVD risk > 15% not on Aspirin

Reg 5 Yr CVDR >15% no Asprin


All patients with 5 yr CVD risk > 15% not on Statin

Reg 5 Yr CVDR >15% no Statin


Registered patients with IHD that have not had cholesterol recorded in the last year

Reg IHD no Chol Rec last 1 Yr


Registered patients with IHD (diagnosis or nitrate prescription) without Aspirin prescription in the last six months

Reg IHD no Asprin Rx last 6 Mth


Registered patients with IHD diagnosis that are not on a beta blocker

Reg IHD Dx not on BB


Registered patients with IHD diagnosis that are not on a statin

Reg IHD Dx not on Statin


Registered patients with DM that have not had an ACEI in the last 6 months

Reg DM no ACE last 6 Mth


Registered patients with DM that have not had a Statin in the last 6 months

Reg DM no Statin last 6 Mth

Read Coding Management

All patients under 45 on inhaled steroid not recorded as having asthma

Reg 45 < on Inhaled Steroid no Asthma Rec


All patients with prescription for hypoglycemic not recorded as having DM

Reg Rx Hypoglycemic no DM Rec


All patients with prescription for nitrate not recorded as having IHD

Reg Rx Nitrate no IHD Rec


All patients with prescription for depression but no diagnosis recorded

Reg Rx Depression no Dx Rec

CPI Report Current Smoker status recorded Current SM Status Rec

CPI Report Diabetes Patients wth HbA1C 8 or below at last annual check (if part of Diabetes Get Checked) or in the last year ( if not part of the Diabetes Get Checked)

DM, with HbA1c <=8 last 1yr

CPI Report Diabetes recorded in the past year (Get Checked)

DM Rec last 1 Yr




CPI Report Diabetes ever recorded DM Rec

CPI Report Heart failure ever recorded Heart Failure Rec

CPI Report Ischaemic CVD event ever recorded Ischaemic CVD event Rec

CPI Report Myocardial infarction ever recorded Myocardial infarction Rec

CPI Report Smoking status ever recorded SM Stats Rec

CPI Report Stroke ever recorded Stroke Rec

CPI Report CVD risk Recorded in the Last 5 years CVDR Rec last 5 Yr

CPI Report Patients having their CVD risk recorded as >=15% in the 5 years

CVDR Rec as >=15% last 5 Yr

CPI Report Statins prescribed when CVD risk >- 15% Statin prescribed when CVDR >15%

CPI Report Diabetes patients recorded as having a microalbuminuria test in the last 18 months

DM Rec, Microalbu last 18 Mth

CPI Report Diabetes patients who have had a positive microalbuminuria test and are on ACE inhibitor or A2 Receptor against at last annual check

DM, Microalbu +ve on ACE or A2 L DIAP

Usage Notes The following instructions should be followed to use CAT correctly under specific scenarios:

To proceed further if “Zero Records” found scenario encountered.

If a user comes across a scenario where zero records are found and tries to do a cross tabulation by clicking any other action menu then a warning pop will be shown with the following message – “Selected conditions found no records, please press “OK” to Clear Conditions and proceed further”.

Exporting to Excel Sheet – Out of Memory Exception If a user wants to export a huge volume of Patient data into an excel sheet an “Out of Memory Exception” can occur under circumstances where the users machine has low memory or lot of other processes are running in parallel using the full system resources. If a user encounters this sort of error they will have to filter the data even further to reduce the record count.

Clinical Audit Tool - Medtech Global · not have CVDR recorded HN (M/P/I) F 45-74 no CVDRA Rec All...

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